[Ventricular septal defect in acute myocardial infarction]

Area of Science:

• Cardiology
• Cardiac Surgery
• Intensive Care Medicine

Background:

• Ventricular septal rupture (VSR) is a critical complication following acute myocardial infarction (MI).
• It represents the fourth leading cause of mortality post-MI, after cardiac arrhythmia, acute heart failure, and cardiac wall rupture.
• Diagnosis is typically aided by identifying a systolic jet sound, though differentiation from papillary muscle rupture can be challenging acutely.

Observation:

• Myocardial rupture, including VSR, generally occurs within the first week post-MI, not immediately.
• Vasodilatory therapy offers temporary hemodynamic stabilization, facilitating diagnostic procedures like cardiac catheterization and coronary angiography.
• Surgical intervention, including defect occlusion and potential saphenous vein bypass, is the current treatment of choice.

Findings:

• In a cohort of three VSR patients, surgical occlusion was successful in two cases.
• One patient with severe cardiogenic shock experienced immediate symptom resolution and an uncomplicated postoperative recovery.
• The third patient, aged 77 with vascular sclerosis, did not undergo surgery and succumbed to cardiogenic shock within 11 hours.

Implications:

• Prompt surgical repair of VSR can significantly improve survival rates and reverse cardiogenic shock.
• Timely diagnosis and surgical intervention are crucial for managing this life-threatening MI complication.
• Patient selection for surgery should consider age and comorbidities, balancing risks and benefits.